Compliance & Value-Based Care
Healthcare Business Insights
Making Healthcare More Consumer-Friendly Through
a Bundled Payment Approach
Hospitals across the country are continu-
ing to invest in more innovative ways to
deliver services and care, all with the goal
of achieving true value-based care. Many of
those organizations are investigating new
means of care access, treatment, and reim-
bursement in an effort to make healthcare
more consumer-friendly.
Geisinger Health Plana not-for-profit
health maintenance organization located
in Pennsylvaniamade it a priority to
be innovative in this area by simultane-
ously increasing adherence to clinical best
practices and lowering the cost of care.
Geisinger accomplished this by creating
a performance-based bundled payment
program wherein a global payment from
Developing a System to Implement an Electronic Clinical
Quality Measures Program
The healthcare industry is becoming
increasingly electronic, with most organi-
zations utilizing some kind of electronic
health record (EHR) to assist with com-
municating patient history and many using
electronic ordering, tracking, or recording
systems in order to handle daily care pro-
cesses. With this turn toward technological
innovation and its use in simplifying pro-
cesses for hospital staff, it is not surpris-
ing that innovators are now moving toward
utilizing technology to track important
quality measures. Submitting electronic
clinical quality measures (eCQMs) instead
of paper-based documents is an evolving
effort to streamline reporting and align
eCQM Data Reporting Periods and Submission Deadlines
Source: The CMS Healthcare Quality Conference
CY 2015 Quarter Reporting Period (2015)
1 January 1stMarch 31st
2 April 1 June 30
st th
3 July 1 September 30
st
It can be important for some organizations to be aware of reporting and submission time frames to
best adjust eCQM validation processes accurately.
the health plan covers all aspects of care,
including pre-admission, inpatient, and
follow-up care at a Geisinger facility. In
fact, any related care, including readmis-
sion due to complications, within a 90-day
period, is also built-in.
By developing this program we were
essentially redesigning how we took care
of the patient and how we paid for the
care, says Dr. John Bulger, Chief Medical
Officer at Geisinger Health Plan and former
Chief Quality Officer for Geisinger Health
System. The partnership between the clin-
ical side and the Health Plan made it pos-
sible for everyone in the system to be on
SEE Payment ON PAGE 2
measures across care settings, but not an
effort void of obstacles and multiple revi-
sions by a team dedicated to informatics
and quality analytics.
The University of Chicago Medicinea
600-bed adult and pediatric hospital and
the No. 11 ranked medical school in the
countryimplemented an EHR in 2002
and formalized an eCQM structure in 2013.
Through developing specific team roles
and changing workflows, the organization
has begun to prepare for the incorporation
of a system-wide eCQM submission pro-
gram and the integration of electronic and
manual clinical quality measure documen-
tation and validation processes.
Finalized Submission Deadline (2015)
November 30 th
November 30 th
th
November 30 th
September 2015
Cost & Quality Academy Journal
Geisinger Health Systems
Coronary Artery Bypass Graft
(CABG) 30-Day Readmission Rates
6.9%
3.8%
Pre- Post-
Implementation Implementation
After implementing a bundled payment pro-
gram, Geisinger reduced its 30-day readmis-
sion rate for CABG patients by nearly half.
The Academy spoke to Michael Wall,
Executive Director of Analytics Improvement
and Insight at the University of Chicago
Medicine, who shared the organizations
best practices and processes in develop-
ment and assessment of the electronic
quality measures submission process.
Developing Work Teams
In 2012, the University of Chicago Medicine
focused on implementing an eCQM struc-
ture in its organization and formalized a
plan of action in 2013 to meet Meaningful
Use requirements. A core leadership team
composed of Wall who is also the Director
of the Center for Quality Analytics, the
Chief Medical Information Officer, and
the Director of Clinical Applications gath-
ered to determine how the process could
best be undertaken. Soon the Meaningful
Use project manager; Manager of Quality
Reporting, Evaluation, and Education;
informatics team; quality intelligence spe-
cialists; and pharmacistsamong other
staffjoined the conversation.
SEE eCQM ON PAGE 3
 Compliance & Value-Based Care
From Payment ON PAGE 1
the same page and work towards the goal
of improving care for the patient.
Designing the Program
Geisingers bundled payment program,
which began in 2006, originally focused
on coronary artery bypass graft (CABG)
patients. After finding that there was a level
of variability in the manner in which care
was delivered by different providers, the
organization selected a physician cham-
pion to reformat the care for patients with
CABG. The ultimate goal of this care rede-
sign was to reduce the amount of variation
and the complications that could occur as a
result. After the evidence-based best prac-
tices suggested by the physician champion
and his team were agreed upon by leader-
ship, Geisinger providers were required to
fulfill these practices and techniques for
every patient observed and treated.
CABG was a narrow enough surgery that
we could easily define best practices, Dr.
Bulger explains. It was chosen because a
small group of clinicians who specialized
on these patients set the specific steps that
should be followed for every case. Because
it was a smaller group, it was easier for
them to hold themselves accountable on
these new requirements.
In order to track the results of these
efforts, Geisinger developed internal ana-
lytics for the CABG bundlenamely, pro-
vider adherence to best practices and
the newly developed processes as well
as quality outcomes for the patients.
COPYRIGHT HEALTHCARE BUSINESS INSIGHTS. ALL RIGHTS RESERVED.
Comparing the data gathered from before
the program in 2006 to the present reveals
significant improvement to all tracked
metrics. For example, the organization
reduced its 30-day readmission rate by
44%. In addition, in-hospital mortality rate
was reduced by 80% and the average total
length in stay improved slightly, going
from an average of 6.2 days to 5.7.
Geisinger Health Plans Current Bundled Payment Programs
Adult Prevention
Bariatric Surgery
Chronic Kidney Disease
Chronic Obstructive Pulmonary Disease
Coronary Artery Bypass Graft
Coronary Artery Disease
After successfully improving the cost and the quality of care with CABG, Geisinger expanded its
bundled payment program to cover 12 episodes of care.
2
Expanding Bundled Payments
With such positive results received from
the CABG bundled payment program, the
collaborative effort between the Geisinger
clinic enterprise and the Geisinger Health
Plan expanded to include additional care
episodes throughout the years, including
bariatric surgery, lumbar spine surgery,
and joint replacement among many others.
Each episode of care went through a pro-
cess similar to CABG with leadership com-
ing to consensus on which evidence-based
techniques were to be utilized and how
providers would be accountable for using
them during care.
Each episode is chosen for several rea-
sons, Dr. Bulger says. On a regular basis,
we look at a disease state to determine
the amount of variation in the practice
and the cost of care. If we think that stan-
dardizing best practice care will reduce
the variation and cost, its natural for pro-
viders to be on board and want to make it
easier for the patient.
Promoting Patient Understanding
A necessary step to seeing improvements
with bundled payment efforts is ensuring
that patients understand their status and
treatment options under the updated sys-
tem. Geisinger created the bundled pay-
ment program with the intention to engage
patients in their own care and encour-
age a better and more open relationship
between patients and physicians.
Better patient engagement is accom-
plished in many ways at Geisinger, but the
emphasis is on improving patient under-
standing through a number of methods
like open dialogues, technology-based
educational materials, and easy-to-under-
stand patient handouts. For example,
to allow patient education to be more
patient-friendly and modern, Geisinger
has developed various iPad videos and
interactive materials to explain particu-
lar procedures and their associated costs.
Diabetes
Fragility Hip Fracture
Heart Failure
Hypertension
Lumbar Spine Surgery
Osteoporosis
Usage Rate of Geisinger Health
Plans Diabetes Management Bundle
12.5%
7.2%
2.4%
Month 1 Month 2 Month 3
The first three months after the implementation
of the diabetes management bundle produced
a steady increase in the use of the bundled
payment program, beginning many patients
journey to gaining control over diabetes.
Patients are also given handouts and
booklets, which can be taken home, to
explain the cost of care, what kinds of ser-
vices fall under the cost, and brief descrip-
tions as to what can be expected before,
during, and post-surgery.
Providers also play a vital role in this edu-
cation process and are expected to have
a discussion with the patient about what
to expect as soon as the patient has been
determined to need a certain kind of treat-
ment. For a patient that must have a knee
replaced, for instance, the doctor must dis-
cuss certain items, such as how much pain
to expect after the surgery and throughout
rehab, how long the patient will most likely
have to remain in the hospital after the
procedure, how long the procedure gen-
erally takes, and what will be taking place
during the actual operation.
Its clear that the more informed a patient
is, the more likely the procedure will
go smoothly and the more satisfied the
patient is with what happens, Dr. Bulger
says. That being the case, we try to be
transparent so that patients understand
what is happening with their care. Most
of what we try to do is partner with the
patient so that were all on the same page.
While many organizations are moving into
experimenting with new payment mod-
els and their effects, investing time and
resources into the unfamiliar can still
seem like a daunting task. By looking at the
positive experiences of organizations such
as Geisinger, however, other institutions
interested in advancing more innovative
approaches to care delivery can gain valu-
able insight into ensuring that their efforts
are similarly successful.

From ECQM ON PAGE 1
Unlike some organizations in which this
process falls solely to the clinical appli-
cations team, the University of Chicago
Medicines quality department is leading
the alignment preparation and relevant
coordination and oversight for the devel-
opment of the eCQM implementation. The
department has paired with the clinical
applications team to help provide a wider
range of expertise to this topic area in
order to develop the most effective process
of implementation and procedural prac-
tice. The organizations plan is to redirect
its multidisciplinary teams to work with the
electronic measures with a specific focus
on EHR.
The skill set required to master these elec-
tronic quality measures is so evolved from
the core measures we started with in 2002,
says Wall. A big piece of our work now is
project management and team facilita-
tion, in addition to having the measure and
electronic health record expertise.
Although many roles within the organi-
zation were adjusted to focus more on
the eCQM structure, data abstractors
will require the most adaptation over
time. Currently, the University of Chicago
Medicines abstractors are not fully tran-
sitioned to the electronic system as some
clinical measures have not yet been inte-
grated electronically throughout the
nation. For example, abstractors still per-
form manual chart review for measures
such as sepsis, which is moving to the
eCQM side in October by mandate of the
Centers for Medicare & Medicaid Services.
Validating and Assessing Workflows
Initially, the organization trained a qual-
ity intelligence specialist to review the
new metrics and existing clinical proce-
dures. This individual collaborated with
the team to review these two components
eCQM Implementation Process
Source: American Hospital Association (2013)
Data Capture and
Workflow Redesign
Gap Analysis
Data Extraction and
eCQM Calculation
The implementation process for clinical quality measures submitted electronically is continuously
adjusting as new measures are added and a gap analysis is performed, demonstrating the need for
a structured system or group to facilitate the process of workflow and process redesign.
The University of Chicago Medicine
Bed Size: 600 staffed beds
Net Patient Revenue: $1.4 billion
Annual Discharges: 25,465
and assess how the metrics and proce-
dures could integrate effectively. With this
first step completed, the team worked
closely with the clinicians to create the
organizations clinical workflows that com-
plemented the metric requirements but
simultaneously minimize the potential for
any procedural bottlenecks or stops in the
daily process flow.
The new workflows at the University of
Chicago Medicine needed a validation
model to ensure the accuracy of docu-
mentation and address only the neces-
sary improvements. Thus, the organization
enacted its current validation process,
which follows the steps through the devel-
opment and testing of the clinical mea-
sures, reviewing the results and data,
comparing the electronic measures to
those cases manually abstracted, and then
sharing and discussing the identified dif-
ferences between the manual and elec-
tronic measures.
For one of the VTE prophylaxis measures,
we have about 45 cases for the manual
core measures and on the electronic met-
ric for the same time period, we have more
than 1,100 cases, Wall says. We match up
those 45 cases from one to the other and
we look for differences. Where there are
differences, we make sure that the clinical
teams and the work groups understand the
differences and how our performance will
change in the future.
The preparation for the transition into
electronic metrics has not been short of
complications as a great amount of effort
is required to make the system functional
Downstream Uses
Validation
of eCQM Results
Compliance & Value-Based Care
Chicago, Illinois
and accurate. This has been emphasized
with the development of VTE performance
metrics. Since the eCQM submission is
tied to the EHR, the abstraction can be
augmented by best practice tools and dot
phrases, whereas with manually collected
metrics, the notes from chart review can
provide much of the necessary data. Even
so, due to the use of this eCQM process,
the organization strived to build the sys-
tem to abstract discrete data and is con-
tinuously assessing for improvements in
this area.
% of Patients Reaching Million Hearts
Goal Through Hospital eCQM Adoption
Source: U.S. Centers for Disease
Control and Prevention (2013)
39%
33%
2013 2011
Adoption Adoption
Early adopters of the eCQM process have
been able to help a greater number of pa-
tients adequately control their blood pressure,
showing eCQMs can help organizations cre-
COPYRIGHT HEALTHCARE BUSINESS INSIGHTS. ALL RIGHTS RESERVED.
ate successful improvement initiatives.
Having the right team, getting the right
skills to the table, and having a mix of
clinical and informatics skills is definitely
needed, Wall notes.
For other organizations looking to develop
system-wide workflows for the eCQM pro-
cess much like those of the University
of Chicago Medicine, creating a team or
teams with defined roles to help imple-
ment quality and assisting staff members
in role changes through the manual to
electronic system may help in creating a
smooth transition. Adjusting processes,
validating data, and ensuring documenta-
tion compliance are all important aspects
to the electronic submission procedure
that may aid facilities in addressing accu-
racy and effectiveness in this field.
3
 Compliance & Value-Based Care

Defining Appropriate Physician Professional Appearance

Given the varying staff that a hospital may
employ and the variety of scrubs commer-
cially available, some patients have diffi-
culty in discerning between a physician, a
physician assistant, and an environmental
services worker during their hospital stay.
This is compounded by the fast-paced
nature of hospital care, which can mean
that a large number of staff members may
enter and exit a given patients room in a
short period of time, often without identi-
consistent, positive experience for patients
% of Patients Who Feel
and visitors interacting with clinical staff. Aspects of Attire Impact Trust
It also offers guidelines for situations in Source: Au S, et al. (2013)
which the appropriateness of a staff mem-
bers appearance comes into question,
stating that staff members should opt for a Name Tag 77%
more conservative and subdued standard
whenever possible. As physicians are often Neat
65%
Grooming
viewed as the professional face of a health-
care organization, standardizing appear- Professional
59%
ance can be effective in conveying a clean, Dress

fying themselves or their roles. trustworthy, and professional image to

While The Academy has previously cre-
ated case studies and developed resources
regarding uniform policies for scrubs-
wearing hospital staff members, physician
appearance has long been non-standard-
ized in many hospitals and health systems.
To address this need, The Academy has cre-
ated a Physician Professional Appearance
Policy template for our members use,
convenience, and edification.
The Physician Professional Appearance
Policy offers a useful framework for orga-
nizations seeking to bolster their cur-
rent policy or create new guidelines from
scratch. The document provides the rea-
soning and rationale behind implementing
a standardized physician appearance pol-
icy, noting its use in assisting to ensure a
patients, visitors, and colleagues.
The document also provides guidance on
many elements of the clinicians physical
appearance and dress:
Position and condition of photo identifi-
cation badges
Examples of inappropriate attire,
including open-toe shoes and floor-
the appearance of patient-facing staff mem-
length or backless dresses
Guidelines for acceptable footwear
Requirements for pant style, length, and
tailored design
Examples of organization-specific
appropriate shirt styles, including dress
shirts and polo shirts
Special attention is also given to appear-
ance accessories, like jewelry, tattoos, and
A study conducted in the ICU, resulted in
patients rating professional traits as most im-
portant when forming a relationship with their
physician, showing the importance of system-
wide guidelines on clinical dress code.
piercings, as well as the rules for grooming
and hygiene, hair, and facial hair.
For organizations seeking to standardize
bers like physicians, this policy can provide
a useful template for either the creation of a
new policy or the reinforcement of an exist-
ing policy. Given the value patients place on
being able to identify the personnel involved
in their care and the potential impact of that
recognition on patient satisfaction, stan-
dardizing the appearance expectations of
physicians can significantly impact the care
experience patients have in a hospital.

Now Available on The Academy Member Portal

Director of Clinical Informatics Physician Professional
COPYRIGHT HEALTHCARE BUSINESS INSIGHTS. ALL RIGHTS RESERVED.

Job Description Appearance Policy

hbinsights.com/viewid/58608
This job description details the roles and re-
sponsibilities, position summary, qualifications,
and experience requirements for the position
of a clinical services informatics director in the
healthcare industry. The description provides
insight into qualities and licenses useful to this
position and its role in healthcare.
hbinsights.com/viewid/58607
This tool discusses a potential dress code for
clinical staff at a hospital or health system.
As a representative of the organization, it is
important for staff members to adhere to ap-
pearance standards. Included in the policy are
guidelines for identification, attire, accesso-
ries, hygiene, and proper enforcement.

Suggested Keywords to Search: Clinical Informatics, Clinical Suggested Keywords to Search: Dress Code, Professional
Services Informatics Director, Electronic Information Director Appearance, Clinical Staff Dress Code, Professional Hygiene

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Compliance & Value-Based Care

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